Prevention of Perioperative Infection Initiative launches Mon. May 11

Improving infection control in the operating room is emerging as an ever-more essential need in the COVID-era. Centered on the evidence-based recommendations by the Anesthesia Patient Safety Foundation (APSF) we are implementing a “Prevention of Perioperative Infection Initiative” across all anesthetizing locations at Froedtert Hospital. This initiative aims to decrease the risk of transmission of SARS-CoV-2 and other microorganisms through simple, practical practice changes. The changes are three-pronged and consist of:

• Designating clean and dirty work areas

• • Dirty areas
    • The anesthesia workstation will be the designated dirty area including the anesthesia machine and computer. This means all used items should be placed in this area. This area should be wiped down with the disinfectant wipes after induction of anesthesia and anytime that the area becomes soiled.
    • A plastic bin with a plastic bag draped over the bin will be placed on the anesthesia workstation between each case. The dirty laryngoscope and stylet should be placed in this bin immediately after use. Close the plastic bag after induction is complete and the anesthesia tech will remove this between cases. The bin and bag can be placed on the floor if space is
      needed on the anesthesia machine surface.
    • In the future, the plastic bin will be replaced with an IV pole mounted wire holder which holds the plastic bag. These have been ordered and will be a better permanent solution.
    • Continue to double-glove for intubation and extubation. The dirty gloves should be removed prior to use of the anesthesia workstation or touching anything on the workstation or in the clean area (see below).
  • Clean areas
    • • The Pyxis will be considered a clean area and no dirty/used items should be set on the Pyxis. You must sanitize hands or don clean gloves prior to accessing the Pyxis and the mounted containers.
      • The C-locker with the anesthesia supplies is also a clean area. The door must remain closed throughout the cases. Hand hygiene must be performed prior to access.

• Frequent hand hygiene practice

  • The provider should perform hand hygiene frequently. This can be done by using hand sanitizer or washing hands outside of OR. Currently we only have the wall-mounted hand sanitizer but a foam hand-pump sanitizer will be mounted on the anesthesia workstation when supplies are available.
  • World Health Organization “moments of hand hygiene” include:
    • before touching a patient,
    • before clean/aseptic procedures,
    • after body fluid exposure/risk,
    • after touching a patient, and
    • after touching patient surroundings.

• Improved vascular access care

  • All IV line ports must have disinfectant caps.
    • Use of 3-way stopcocks is a significant, independent risk factor for catheter-related bloodstream infections based on a randomized controlled trial published in the American Journal of Infection Control. The stopcock requires either a red female disinfectant cap or a clear adaptor with a large green cap.
    • All injection ports must have the large green caps.
    • Red female caps should be placed on arterial line transducers.
    • The thin green caps can be used to clean IV line tips if disconnected from patient.
    • It takes 1 minute for disinfection to occur and the caps are SINGLE-USE ONLY. You must place a new cap after accessing any site on the IV line.
    • An alcohol swab must be used to clean visibly soiled IV access sites.
    • The anesthesia techs will be hanging two strips of green caps on the IV poles between cases. When these strips are used during a case, they are then dirty and cannot be re-used for another patient. Additional green and red caps will be in the mounted Pyxis cubies.

These new practices will go live Monday, May 11, 2020.

Please contact the Anesthesia Clean Task Force with questions:
Tara Alauf
Lyndee Andzalone
Matt Jeranek
Roz Thapa
Jason Vitek
Jenea Waraxa

These guidelines are also available in the Clinical Resources section of A-Net.